Public Health Project NUR 455

Elizabeth Hotaling, RN Helen McDonald, RN

Healthy People 2020 Topic: Heart Disease & Stroke

Objective: Reduce Stoke Deaths

Baseline Data
According to Healthy People 2020, as of 2007 there were 42.2 stroke deaths per 100,000

Target
The target for 2020 is 33.8 stroke deaths per 100,000

Population of Focus
African-Americans are at a higher risk for stroke

Stroke facts
Stroke is the 4th leading cause of death in the U.S. Up to 80% of strokes are preventable More than 2/3 of stroke survivors will have some type of disability African Americans have almost twice the risk for stroke compared to Caucasians. The estimated cost of stroke in the U.S in 2010 was 73.7 billion dollars.

African Americans and Stroke

In 2009 there were 55.7 per 100,000 African American stroke deaths compared to 37.8 per 100,000 Caucasian stroke deaths. African Americans have an increased prevalence of risk factors for stroke including: obesity, hypertension, high cholesterol, and cigarette smoking.

African Americans and Stroke Risk Factors

per the National Stroke Association: One in three suffer from high blood pressure Have a higher rate of diabetes Sickle Cell Anemia is the most common genetic disorder. A sickle shaped cell can block a blood vessel to the brain and stroke can result. Smoking doubles the risk of stroke.

Compared to Caucasians, African Americans:

Have twice the mortality from stroke Have more severe and disabling strokes Women have a lower one year survival rate following an ischemic stroke Are significantly less likely to receive tPA which is the only FDA treatment for stroke

African American Disparity

A 2011 study published in the American Journal of Health Behavior reports the following possible factors for health disparity in African Americans: Genetic disposition Developmental and environmental exposures Racial discrimination and perceived racism Life experiences and stressful events Psychosocial exposures Socioeconomic position Lifestyle behaviors

Public Health Programs for Stroke Prevention

States including New York began to receive funding from the CDC in 1998 for a heart disease and stroke prevention program NYS partners with other states to collaborate on stroke prevention programs. Public health partnerships with African American Churches. Development of a multi-media stroke prevention program Designated Stroke Centers

Partnerships with African American Churches

Pastors have a strong influence on individuals in the community and play an important role in successful implementation of health programs. Partnerships decrease health disparities in this population by reaching individuals who lack transportation and funds. Early interventions in the community setting can help decrease incidence of stroke.

Multi-Media Campaign
(Per the Northeast Cerebrovascular Consortium)

Television Ads Reverse Hospital and Stroke Heroes ACT FAST Radio Ad Ticking Clock developed by Utah DOH Information through transit at bus shelters, inside and outside public buses Printed Materials table tents, pharmacy cards, and magnets

Television Ads
The Act F.A.S.T. Campaign includes multiple TV commercials including this one developed by the Massachusetts Department of Public Health Stroke Heroes Act Fast YouTube Several other television ads; including ones developed by the American Heart Association and American Stroke Association American Heart Association Stroke Awareness Campaign Symptoms spot - YouTube

Radio Ads
There are multiple radio ads that help educate individuals on stroke signs and symptoms Stroke Awareness Campaign, VDH - Meeting Radio Announcement YouTube

Educational elements of Multi-Media Campaign

Uses the F.A.S.T. mnemonic Emphasizes to call 9-1-1 Uses a catchy jingle to help the audience memorize important information Discusses five warnings signs in relation to Walk, Talk, Reach, See, Feel

NYS Designated Stroke Centers

The NYS DOH designates stroke centers statewide to improve the standard and access to quality of care for patients with a presumptive diagnosis of stroke. The Bureau of Emergency Medical Services (EMS) working with the DOH to maintain a list of designated stroke centers, allowing any potential stroke victims to be brought directly to a stroke center, and have the NYS BLS Stroke Protocol initiated immediately.

The Capital Region Stroke Networks

In the Capital Region Albany Medical Center, St. Peters Health Partners (including Albany Memorial, Samaritan, and St. Marys hospitals), and Ellis Hospital are designated stroke centers

Effectiveness
Per Health People 2020: Between 2007 and 2010 there was a decrease in the number of stroke deaths per 100,000 for the general population of 3.1 deaths per 100,000 For African Americans, there was a decrease in the number of stroke deaths per 100,000 of 7.3 This demonstrates effectiveness of educating African Americans on stroke prevention, signs, symptoms, and actions to take.

Effectiveness
2007 Total Population Stroke Deaths per 100,000 African American Stroke Deaths per 100,000 42.2 2008 40.7 2009 38.9 2010 39.1

60.3

57.4

54.5

53.0

Effectiveness of Multi-Media
A study conducted by the NYS DOH and University at Albany School of Public Health examined four focus groups regarding stroke prevention, and their reaction to the multi-media campaign. Two of these focus groups were African American In regards to knowledge of stroke symptoms and response, the study found that African Americans were more influenced by culture and family history, more likely to wait and watch the symptoms and then decide, and they were less likely to use 911 prior to seeing any of the multi-media campaigns.

Effectiveness of Multi-Media (cont.)

After exposure to the TV, radio, and bus ads, the study demonstrated an overall increase in the number of people who would NOT wait, and WOULD dial 911. The study concluded that a multi-media stroke prevention can increase the number of individuals who dial 9-1-1, and recommends consistent, sustained media messages.

Effectiveness of Designated Stroke Centers

A 2011 meta-analysis study published in the American College on Emergency Physicians, reports that stroke unit care is associated with a 21% reduction in death from stroke. Stroke Centers:
Improve clinical outcomes Increase the use of TPA Provide more efficient care and are more effective at initiating secondary medications Reduce death

Beths Analysis
Per Sullivan, White, Young, & Scott (2010): Stroke prevention programs should utilize four factors regarding health beliefs:
Benefits of preventative care Barriers to preventative care Perceived Illness Severity

Beths Analysis
The multi media campaign provides stroke information in a manner that may be extremely effective for the population of African Americans. By using TV, radio, and bus advertisements the campaign is able to reach millions of people including African Americas. The media campaign appears to take into account the factors regarding health beliefs. Could be more effective if campaigns were nationally consistent

Beths Analysis
Designated Stroke Centers will be effective for decreasing stroke deaths in African Americans by ensuring best practices of care, as long as they are utilized. This reinforces the need for all populations to know when to dial 9-1-1, and arrive at a stroke center via ambulance.

Helens Analysis
The multi-media campaign will be effective to educate mass populations of individuals, regardless of race, ethnicity and income. Campaign ad placement will be integral to reaching focus populations. Ads need to be high quality, interesting and culturally sensitive to catch attention of focus populations.

Helens Analysis
People in general may not perceive stroke as an immediate problem needing to be addressed. They may dismiss campaign ads. They may be reluctant to change behaviors to decrease risk factors. People need to feel empowered to have an active role in their healthcare decisions rather than enabling or providing help. People need to have
Access and control over needed resources Decision-making and problem solving ability The ability to communicate and obtain needed resourses

Helens Analysis
Collaborating with African American Churches will help target the high risk population identified. Early interventions to decrease risk factors can be implemented. Ex: Blood pressure and diabetes checks, health fairs. Pastors of the community need to be a part of early program planning to assist with cultural sensitivity and strategies to reach the targeted group.

Helens Analysis
Increasing awareness of designated stroke centers as well as increasing the amount and availability of these centers will help to decrease time intervals for transportation to treatment.

References
Butler-Ajibade, P., Booth, W., & Burwell, C. (2012). Partnering with the Black Church: Recipe for Promoting Heart Health in the Stroke Belt. ABNF Journal, 23(2), 34-37.

Deuster, P. A., Su Jong, K., Remaley, A. T., & Poth, M. (2011). Allostatic Load and Health Status of African Americans and Whites. American Journal Of Health Behavior, 35(6), 641-653. Retrieved from:
http://search.ebscohost.com.ezproxy.sunyit.edu/login.aspx?direct=true&db=rzh&AN=2011471715&site=ehost-live

Johnston, C. (2011). Does Stroke Center Designation Improve Patient Outcomes? The American College of Emergency Physicians. Retrieved from: http://www.acep.org/MobileArticle.aspx?id=82874&coll National Stroke Association. (2013). African Americans and Stroke. Retrieved from: http://www.stroke.org/site/PageServer?pagename=AAMER New York State Department of Health. (2012) Stroke Centers. Retrieved from: http://hospitals.nyhealth.gov/learn.php?t=SC&PHPSESSID=728a3d329e1d6b4b6130acce22a33a99 Spicer, D., Howland, T., Brissette, I., Dennison, B., Maniccia, D., Jurkowski, J. (n.d.) Stroke Awareness Impact of a Multi-Media Campaign. The Northeast Cerebrovascular Consortium. Retrieved from: http://www.thenecc.org/images/Howland.pdf Sullivan, K., White, K., Young, R., & Scott, C. (2010). The Cerebrovascular Attitudes and Beliefs Scale (CABS-R): the factor structure and psychometric properties of a tool for assessing stroke-related health beliefs. International Journal Of Behavioral Medicine, 17(1), 67-73. doi:10.1007/s12529-009-9047-3 Retrieved from: http://search.ebscohost.com.ezproxy.sunyit.edu/login.aspx?direct=true&db=rzh&AN=2010551377&site=ehost-live Stanhope, M. & Lancaster, J. (2012). Public Health Nursing Population-Centered Health Care in the Community. Missouri: Mosby.